[go: up one dir, main page]

WO2006012193A1 - Appareil et procédé pour fixer un greffon à un dispositif de formation de tunnel - Google Patents

Appareil et procédé pour fixer un greffon à un dispositif de formation de tunnel Download PDF

Info

Publication number
WO2006012193A1
WO2006012193A1 PCT/US2005/022223 US2005022223W WO2006012193A1 WO 2006012193 A1 WO2006012193 A1 WO 2006012193A1 US 2005022223 W US2005022223 W US 2005022223W WO 2006012193 A1 WO2006012193 A1 WO 2006012193A1
Authority
WO
WIPO (PCT)
Prior art keywords
graft
engagement portion
elongated member
proximal end
radially projecting
Prior art date
Application number
PCT/US2005/022223
Other languages
English (en)
Inventor
Jamie S. Henderson
Warren A. Joeckel
Joseph Megerman
Original Assignee
Scimed Life Systems, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Scimed Life Systems, Inc. filed Critical Scimed Life Systems, Inc.
Priority to DE602005024562T priority Critical patent/DE602005024562D1/de
Priority to EP05762684A priority patent/EP1773216B1/fr
Priority to CA002572080A priority patent/CA2572080A1/fr
Priority to AT05762684T priority patent/ATE486530T1/de
Publication of WO2006012193A1 publication Critical patent/WO2006012193A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0805—Implements for inserting tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0847—Mode of fixation of anchor to tendon or ligament
    • A61F2002/0858—Fixation of tendon or ligament between anchor and bone, e.g. interference screws, wedges
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/08—Muscles; Tendons; Ligaments
    • A61F2/0811—Fixation devices for tendons or ligaments
    • A61F2002/0876—Position of anchor in respect to the bone
    • A61F2002/0882—Anchor in or on top of a bone tunnel, i.e. a hole running through the entire bone

Definitions

  • This invention relates generally to surgical instruments, and more particularly to instruments known as "tunnelers,” used for subcutaneous placement of arteriovenous grafts for extracorporeal circulation of the blood, arterial bypasses, and the like.
  • tunnelers currently in use utilize sutures or alligator tip clamps to attach the vascular graft to the inner rod of the tunneling devices by which the graft is pulled back through a subcutaneous tunnel made by the tunneler.
  • graft placement with these devices involves surgical manipulation and tissue trauma which can lead to infection and pain or discomfort, and necessarily longer recovery times. For these reasons, improvements in how the tunneler is attached to the graft are highly desirable.
  • An apparatus for securing a graft to a tunneler during implantation of the graft subcutaneously for vascular access.
  • the apparatus includes an elongated member adapted to be tunneled subcutaneously from an entry point at a first location on the skin surface of a patient to an exit point at a second location on the skin surface of the patient.
  • the elongated member includes a proximal end and a distal end.
  • proximal end refers to the end of the apparatus that first enters the patient's body.
  • the apparatus further includes a graft engagement portion at the proximal end of the elongated member.
  • the graft engagement portion includes at least one proximally facing surface adapted to slideably receive, in a direction toward the distal end, the inner surface of a graft.
  • the graft engagement portion further includes at least one radially projecting element adapted to resist movement of the graft, after the graft has been received over the proximally facing surface, in a direction toward the proximal end.
  • the apparatus may include a removable pilot tip for attachment to the proximal end of the elongated member.
  • the removable pilot tip is adapted to facilitate tunneling
  • the engagement portion is adapted to be removably secured to the pilot tip.
  • the apparatus may include an integrated pilot tip at the proximal end of the elongated member adapted to facilitate tunneling.
  • Fig. IA is a modified cross-sectional view of an apparatus for securing a graft to a tunneler which utilizes a removable pilot tip as described herein;
  • Fig. IB is the apparatus as illustrated in Fig. IA with the pilot tip removed, shown engaged within a graft;
  • Fig. 2 is a side view of another apparatus for securing a graft to a tunneler which includes an integrated tip as described herein;
  • Fig. 3 is a side view of yet another apparatus for securing a graft to a tunneler shown without its removable pilot tip as described herein;
  • Fig. 4A is a perspective view of another apparatus for securing a graft to a tunneler shown without its removable pilot tip as described herein;
  • Fig. 4B is a cross-sectional view of the embodiment illustrated in Fig. 4A;
  • Fig. 5A is a perspective view of yet another apparatus for securing a graft to a tunneler shown without its removable pilot tip as described herein ;
  • Fig. 5B is a cross-sectional view of the embodiment illustrated in Fig. 5A;
  • Fig. 6A is a side view of another apparatus for securing a graft to a tunneler which includes a rotatable tip in its pre-engagement position, shown without its removable pilot tip as described herein;
  • Fig. 6B is an end view of the embodiment illustrated in Fig. 6A, shown within a graft;
  • Fig. 6C is the apparatus as illustrated in Fig. 6A with the rotatable tip shown in its engagement position;
  • Fig. 6D is an end view of the apparatus illustrated in Fig. 6C, shown engaged within a graft;
  • Fig. 7 is a modified cross-sectional view of yet another apparatus for securing a graft to a tunneler shown without its removable pilot tip and shown engaging a graft as described herein;
  • Fig. 8 is a modified cross-sectional view of another apparatus for securing a graft to a tunneler shown without its removable pilot tip and shown engaged within a graft as described herein ;
  • Fig. 9 is a modified cross-sectional view of yet another apparatus for securing a graft to a tunneler shown without its removable pilot tip as described herein.
  • a sheath tunneling apparatus 10 including a cylindrically-shaped rod-like elongated member 16 which includes a proximal end 18 and a distal end 20.
  • Proximal end 18 includes an external thread portion 22, as represented in Fig . IA.
  • the sheath tunneler 10 includes, among other things, a sheath 14 and a handle (not shown) attached at distal end 20.
  • Apparatus 10 further includes an engagement portion 24 at proximal end 18 of elongated member 16 including radially projecting elements 26.
  • Engagement portion 24 further includes a base portion 28 and a flexible portion 30.
  • a depression member 32 is integrated into flexible portion 30.
  • a removable pilot tip 34 includes an internal thread portion 36 which mates with external thread portion 22 of proximal end 18, thereby attaching removable pilot tip 34 to elongated member 16.
  • Removable pilot tip 34 further includes an abutment surface 38 for retaining sheath 14 along elongated member 16 between removable pilot tip 34 and the handle of the sheath tunneler (not shown).
  • Flexible portion 30 of engagement portion 24 is biased toward an expanded position as is illustrated in Figs. IA and IB.
  • engagement portion 24 is compressed inwardly, reducing its outer diameter at the location containing radially projecting elements 26. (This compressed position is not shown in the figures.)
  • Elongated member 16, along with sheath 14, is adapted to be tunneled subcutaneously from an entry point at a first location on the skin surface of a patient to an exit point at a second location on the skin surface of the patient.
  • Removable pilot tip 34 is adapted to facilitate tunneling.
  • apparatus 10 including sheath 14, is forcefully passed through the subcutaneous tissue horizontally between two surgically prepared incisions until removable pilot tip 34 is exposed at the second incision or exit wound.
  • Removable pilot tip 34 is then removed from proximal end 18 of elongated member 16 by unscrewing internal threads 36 from external threads 22.
  • engagement portion 24 is adapted to slideably receive, in a direction toward distal end 20, the inner surface of graft 12 over at least one radially projecting element 26 of engagement portion 24.
  • depression member 32 is depressed (not shown) to compress engagement member 24 and reduce its outer diameter at the location containing radially projecting elements 26. Due to the reduced diameter, graft 12 may then be easily slid over proximal end 18 of elongated member 16 and radially projecting elements 26 of engagement portion 24. Depression member 32 is then released, permitting it to return to its expanded position (as illustrated in Fig. IB), thereby increasing the outer diameter of engagement member 24 at the location containing radially projecting elements 26.
  • Radially projecting elements 26 engage the inner surface of graft 12 and are adapted to resist movement of graft 12 in a direction toward proximal end 18. Furthermore, radially projecting elements 26 are adapted to apply outward distension with respect to graft 12. In other words, radially projecting elements 26 provide a secure fit between engagement member 24 and graft 12 by slightly stretching graft 12 outwardly. This secure fit prevents graft 12 from slipping toward proximal end 18 when elongated element 16, with graft 12 attached, is pulled back through the tunnel previously made by tip 34 and its attached components, beneath the skin, and into the implant position. Radially projecting elements 26 are illustrated in Figs. IA and IB as V-shaped.
  • radially projecting elements may be barb-shaped, hook-shaped, or any other shape suitable for achieving the desired engagement.
  • elongated member 16 is pulled back toward the entrance wound utilizing the handle (not shown), thereby drawing graft 12 through the entire length of sheath 16 (still positioned within the subcutaneous passageway).
  • graft 12 With graft 12 positioned in place, material of graft 12 is then cut free from engagement portion 24 and sheath 14 is carefully extracted from the tissue tunnel and exit wound without extracting graft 12 from the subcutaneous passageway.
  • sheath 14 is represented in Figs. IA, IB, 2, and 9 only. However, it is contemplated that each embodiment illustrated in Figs. 3 - 8 is for use with a sheath tunneler. The present invention, however, is not limited to use with a sheath tunneler, and may also be used with a sheathless tunneler.
  • FIG. 2 illustrates an alternative exemplary configuration of an apparatus 40 for securing a graft (not shown) to a sheath tunneler.
  • apparatus 40 includes an integrated pilot tip 42 at proximal end 46 of elongated member 44, thereby eliminating the need for a removable pilot tip.
  • apparatus 40 includes a cylindrically-shaped rod-like elongated member 44 which includes a proximal end 46 and a distal end 48.
  • Apparatus 40 further includes an engagement portion 50 at proximal end 46 of elongated member 44 including radially projecting barb-shaped elements 52.
  • Engagement portion 50 further includes a base portion 54 and a flexible portion 56.
  • a depression member 58 is integrated into flexible portion 56.
  • Elongated member 44 includes an intermediate portion 60 for retaining sheath 14 along elongated member 44 between engagement portion 50 and the handle of sheath tunneler 40. More specifically, a small clearance fit between the outer diameter of intermediate portion 60 and the inner diameter of sheath 14 adequately secures sheath 14 in place. As illustrated, sheath 14 is optionally tapered at its proximal end to facilitate tunneling.
  • elongated member 44 is adapted to be tunneled subcutaneously from an entry point at a first location on the skin surface of a patient to an exit point at a second location on the skin surface of the patient.
  • apparatus 40 is used to dissect a tunnel by forcing integrated pilot tip 42 through the subcutaneous tissue until integrated pilot tip 42 is exposed.
  • integrated pilot tip 42 is adapted to slideably receive, in a direction toward distal end 48, the inner surface of the graft over at least one radially projecting barb-shaped element 52 of engagement portion 50, while radially projecting barb-shaped elements 52 are adapted to resist movement of the graft in a direction toward proximal end 46.
  • the graft After attachment of the graft to engagement portion 50, the graft is drawn through the entire length of sheath 14, material of the graft is cut free from engagement portion 50, and sheath 14 is carefully extracted from the tissue tunnel and exit wound without extracting the graft from the subcutaneous passageway.
  • FIG. 3 illustrates another alternative exemplary configuration of an apparatus 70 for securing a graft (not shown) to a sheath tunneler (not shown). Similar to the assembly of Figs. IA and IB, apparatus 70 requires the use of a removable pilot tip (not shown) at proximal end 74 of elongated member 72.
  • a removable pilot tip is not represented in Figs. 3 - 9.
  • the abutment surface of the removable pilot tip (for retaining the sheath along the elongated member), as represented in Fig. IA as abutment surface 38, is not represented in Figs. 3 - 9.
  • each embodiment illustrated in Figs. IA, IB, and 3 - 9 is for use with a removable pilot tip and includes these features.
  • apparatus 70 of Fig. 3 includes a cylindrically-shaped rod-like elongated member 72 which includes a proximal end 74 and a distal end 76. (Distal end 76 is not actually shown in the figure, but is represented as reference numeral 76 for orientation relative to proximal end 74.) Apparatus 70 further includes a hook-shaped engagement portion 78 at proximal end 74 of elongated member 72 including a radially projecting element 80. Elongated member 72 includes a threaded intermediate portion 82 that engages internal threads of a removable pilot tip (not shown) to facilitate tunneling.
  • elongated member 72 is adapted to be tunneled subcutaneously from an entry point at a first location on the skin surface of a patient to an exit point at a second location on the skin surface of the patient utilizing a removable pilot tip (not shown) to facilitate tunneling.
  • apparatus 70 is used to dissect a tunnel by forcing a removable pilot tip (not shown) through the subcutaneous tissue until the removable pilot tip is exposed. The removable pilot tip is then removed from proximal end 74 of elongated member 72 by unscrewing internal threads (not shown) from external threads 82.
  • Engagement portion 78 is adapted to slideably receive, in a direction toward distal end 76, the inner surface of the graft, while radially projecting element 80 is adapted to resist movement of the graft in a direction toward proximal end 74.
  • the graft may include a hole in its wall for receiving radially projecting element 80.
  • radially projecting element 80 may be hooked into a pre- existing hole in the graft wall.
  • the graft may include a loop at its end for receiving radially projecting element 80.
  • a portion of the graft wall at the underside of engagement portion 78 may be cut at an angle to facilitate its entry into the sheath.
  • the graft After attachment of the graft to engagement portion 78, the graft is drawn through the entire length of the sheath, material of the graft is cut free from engagement portion 78, and the sheath is carefully extracted from the tissue tunnel and exit wound without extracting the graft from the subcutaneous passageway.
  • Figs. 4A and 4B illustrate yet another alternative exemplary configuration of an apparatus 90 for securing a graft (not shown) to a sheath tunneler (not shown). Similar to the assembly of Figs. IA and IB, apparatus 90 requires the use of a removable pilot tip (not shown) at proximal end 94 of elongated member 98.
  • the portion of the apparatus illustrated in Figs. 4A and 4B includes an engagement portion 92 at a proximal end 94 of an elongated member 98.
  • Engagement portion 92 includes radially projecting barb-shaped elements 96.
  • Engagement portion 92 is adapted to slideably receive, in a direction toward the distal end (not shown), the inner surface of the graft, while radially projecting barb-shaped elements 96 are adapted to resist movement of the graft in a direction toward proximal end 94.
  • graft (not shown) may be easily slid over proximal end 94 of elongated member 98 and radially projecting barb-shaped elements 96 of engagement portion 92. This is facilitated by the outwardly tapered cross-section of radially projecting barb-shaped elements 96 with each element including a smaller diameter at its proximal and end expanding in a sloped manner to a larger diameter at its distal end.
  • Radially projecting barb-shaped elements 96 engage the inner surface of the graft, and are adapted to resist movement of the graft in a direction toward proximal end 94 by virtue of their circumferential edge and their non-sloped or flat shape distal of that edge. In other words, the circumferential pointed tip of the distally facing flat surface resists proximal movement of the graft relative to elongated member 98. Furthermore, radially projecting barb-shaped elements 96 are adapted to apply outward distension with respect to the graft. This provides a secure fit which prevents the graft from slipping toward proximal end 94 when the graft is pulled beneath the skin and into the implant position.
  • Figs. 5A and 5B illustrate another alternative exemplary configuration of an apparatus 90 for securing a graft (not shown) to a sheath tunneler (not shown).
  • This embodiment demonstrates an alternative cross section for engagement portion 92, however, the description and operation of this embodiment is virtually the same as that previously described herein with reference to Figs. 4A and 4B.
  • the present invention is not limited to the cross-sectional shapes illustrated in Figs. 4A - 5B.
  • the engagement portion may have a square cross section, a rectangular cross section, a triangular cross section, or any other cross section suitable for achieving the desired graft attachment.
  • Figs. 5A and 5B illustrate another alternative exemplary configuration of an apparatus 90 for securing a graft (not shown) to a sheath tunneler (not shown).
  • This embodiment demonstrates an alternative cross section for engagement portion 92, however, the description and operation of this embodiment is virtually the same as that previously described herein with reference to Figs. 4A and
  • FIG. 6A - 6D illustrate yet another alternative exemplary configuration of an apparatus 100 for securing a graft 112 to an elongated element 114 of a sheath tunneler apparatus (not otherwise shown).
  • the portion of the apparatus 100 illustrated in Figs. 6A - 6D includes an engagement portion 102 at a proximal end 104 of an elongated member 114.
  • Engagement portion 102 includes rotatable radially projecting barb-shaped elements 106.
  • Engagement portion 102 has a rectangular cross section and includes a base portion 108 and a rotatable portion 110 which rotates 90° with respect to base portion 108.
  • Engagement portion 102 is adapted, by virtue of its proximal tapered cross-section, to slideably receive, in a direction toward the distal end (not shown), the inner surface of graft 112, while rotatable radially projecting barb- shaped elements 106 are adapted to resist, by virtue of distally projecting tips, movement of graft 112 in a direction toward proximal end 104.
  • graft 112 may be easily slid over proximal end 104 of the elongated member 114. As illustrated in Fig. 6B, graft 112 is loosely disposed about engagement portion 102. Rotatable portion 110 is then rotated 90° with respect to base portion 108, as illustrated in Figs.
  • rotatable radially projecting barb-shaped elements 106 engage the inner surface of graft 112.
  • rotatable radially projecting barb-shaped elements 106 are adapted to resist movement of graft 112 in a direction toward proximal end 104.
  • rotatable radially projecting barb-shaped elements 106 are adapted to apply outward distension with respect to graft 112, as illustrated in Fig. 6D.
  • graft 112 becomes taut, as opposed to its loose condition represented in Fig. 6B.
  • the secure fit prevents graft 112 from slipping toward proximal end 104 when graft 112 is pulled beneath the skin and into the implant position.
  • rotatable portion 110 may sufficiently engage the inner surface of graft 112 without barb-shaped elements when rotated within graft 112 90° with respect to base portion 108.
  • rotatable portion 110 is adapted to apply outward distension with respect to graft 112, causing graft 112 to become taut.
  • the secure fit of the optional configuration without barb-shaped elements prevents graft 112 from slipping toward proximal end 104 when graft 112 is pulled beneath the skin and into the implant position.
  • Fig. 7 illustrates another alternative exemplary configuration of an apparatus 120 for securing a graft 132 to a sheath tunneler (not shown).
  • the portion of the apparatus illustrated in Fig. 7 includes an engagement portion 122 at a proximal end 124 of an elongated member 134.
  • Engagement portion 102 includes a base portion 126 and a grasping portion 128.
  • Grasping portion 128 includes a radially inwardly projecting barb-shaped catch 130 configured to engage a wall of graft 132 between grasping portion 128 and base portion 126.
  • Base portion 126 of engagement portion 122 is adapted to slideably receive, in a direction toward the distal end (not shown), the inner surface of graft 132, while barb-shaped catch 130 is adapted to resist movement of graft 132 in a direction toward proximal end 124.
  • the operation of the apparatus represented in Fig. 7 is virtually the same as that previously described herein with reference to apparatus 70 of Fig. 3, with an alternative way of attaching graft 132 to engagement portion 122. More specifically, due to the orientation of barb-shaped catch 130, graft 132 may be easily slid over base portion 126 of engagement portion 122.
  • Barb-shaped catch 130 engages the outer surface of graft 132, and is adapted to resist movement of graft 132 in a direction toward proximal end 124.
  • the secure fit prevents graft 132 from slipping toward proximal end 124 when graft 132 is pulled beneath the skin and into the implant position.
  • Fig. 8 illustrates yet another alternative exemplary configuration of an apparatus 140 for securing a graft 154 to a sheath tunneler.
  • the portion of the tunneler illustrated in Fig. 8 includes an engagement portion 142 at a proximal end 144 of an elongated member 148.
  • Engagement portion 142 includes an actuator 146 attached to a pull element 156 and a flexible collet-type grasping portion 150 disposed about actuator 146.
  • Flexible collet-type grasping portion 150 includes outwardly radially projecting barb-shaped catches 152 configured to engage inner surfaces of graft 154.
  • Engagement portion 142 is represented in its actuated position in Fig . 8.
  • actuator 146 In its unactuated position (not shown), actuator 146 is positioned toward the left with reference to Fig. 8, thereby permitting flexible collet-type grasping portion 150 (which is biased radially inwardly) to compress, resulting in a smaller outer diameter at the location containing barb-shaped catches 152.
  • Flexible collet-type grasping portion 150 expands upon movement of actuator 146 toward the distal end (not shown) of elongated member 148, i.e., when pull element 156 is pulled in direction D, causing barb-shaped catches 152 to expand outwardly radially (in direction R, as represented in Fig. 8).
  • Engagement portion 142 is adapted to slideably receive, in a direction toward the distal end, the inner surface of graft 154, while barb-shaped catches 152 are adapted to resist movement of graft 154 in a direction toward proximal end 144.
  • graft 154 may be easily slid over proximal end 144 of engagement portion 142 and barb-shaped catches 152 of engagement portion 142.
  • Actuator 146 is then moved toward the distal end (not shown) of elongated member 148, i.e., pull element 156 is pulled in direction D, causing barb-shaped catches 152 to expand radially in direction R, as represented in Fig. 8.
  • FIG. 9 illustrates another alternative exemplary configuration of an apparatus 160 for securing a graft 182 to a sheath tunneler.
  • Apparatus 160 includes a cylindrically-shaped hollow rod-like elongated member 162 which includes a proximal end 164 and a distal end 166.
  • the sheath tunneler includes, among other things, a sheath 168 and a handle (not shown) attached at distal end 166.
  • Apparatus 160 further includes an engagement portion 170 at proximal end 164 of elongated member 162.
  • Engagement portion 170 includes a conical-shaped actuator 172 attached to a pull element 174 (which may be secured at distal end 166 to the handle via a setscrew or camlock mechanism, (not shown)), a conical-shaped opening 176 for receiving conical-shaped actuator 172, and radially projecting elements 178.
  • Engagement portion 170 also includes a threaded intermediate portion 180 that engages internal threads of a removable pilot tip (not shown) to facilitate tunneling.
  • Engagement portion 170 is adapted to slideably receive, in a direction toward distal end 166, graft 182, while the inwardly radially projecting face 178, in conjunction with conical-shaped opening 176 and mating actuator 172, is adapted to resist movement of graft 182 in a direction toward proximal end 164.
  • apparatus 160 represented in Fig. 9 is virtually the same as that previously described herein with reference to apparatus 70 of Fig. 3, with an alternative way of attaching graft 182 to engagement portion 170.
  • Engagement portion 170 is represented in its unactuated position in Fig. 9. In this position, graft 182 may be easily placed over conical-shaped actuator 172 and, piloted by the conical inner face 178 of opening 176, tucked between conical- shaped actuator 172 and conical-shaped opening 176. Engagement portion 170 may then be actuated (not shown).
  • conical-shaped actuator 172 is moved toward distal end 166 of the elongated member 162, i.e., pull element 174 is pulled toward distal end 166, causing conical-shaped actuator 172 to engage tightly within the inwardly projecting face 178 of conical-shaped opening 176, thereby trapping material of graft 182 between conical-shaped actuator 172 and conical-shaped opening 176.
  • graft 182 is mechanically engaged between conical-shaped actuator 172 and the inwardly projecting face 178 of conical-shaped opening 176 upon movement of conical-shaped actuator 172 toward conical-shaped opening 176.
  • Such mechanical engagement resists movement of graft 182 in a direction toward proximal end 164.
  • the secure fit prevents graft 182 from slipping toward proximal end 164 when graft 182 is pulled beneath the skin and into the implant position.
  • An exemplary material for forming all apparatus components described herein, namely elongated member, engagement portion, radially projecting elements, integrated pilot tip, removable pilot tip, and pull element is stainless steel.
  • the present invention is not limited to this material, and may include any materials, including, for example, metallic (titanium, for example) or non-metallic (a polymer or other composite material, for example) material that offer desired properties including both strength and flexibility.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Animal Behavior & Ethology (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Cardiology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Surgery (AREA)
  • Vascular Medicine (AREA)
  • Transplantation (AREA)
  • Rheumatology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Rehabilitation Therapy (AREA)
  • Medical Informatics (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Pathology (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Prostheses (AREA)
  • Transplanting Machines (AREA)
  • Protection Of Plants (AREA)

Abstract

L’invention décrit un appareil (10) pour fixer un greffon (12) à un dispositif de formation de tunnel lors de l'implantation sous-cutanée du greffon pour un accès vasculaire. L'appareil (10) inclut un élément allongé (16) adapté pour être introduit de manière sous-cutanée à partir d'un point d'entrée en un premier emplacement sur la surface de la peau d'un patient vers un point de sortie en un deuxième emplacement sur la surface de la peau du patient. L'élément allongé (16) inclut une extrémité proximale (18) et distale (20). L'appareil (10) inclut de plus une partie d’insertion du greffon (24) à l'extrémité proximale (18) de l'élément allongé (16). La partie d’insertion du greffon (24) inclut au moins une surface faisant face de manière proximale adaptée pour recevoir de façon coulissante, en direction de l'extrémité distale (20), la surface interne d'un greffon (12). La partie d’insertion du greffon (24) inclut également au moins un élément se projetant de manière radiale (26) adapté pour résister au mouvement du greffon (12), après que le greffon ait été reçu sur la surface faisant face de manière proximale, en direction de l'extrémité proximale.
PCT/US2005/022223 2004-06-28 2005-06-22 Appareil et procédé pour fixer un greffon à un dispositif de formation de tunnel WO2006012193A1 (fr)

Priority Applications (4)

Application Number Priority Date Filing Date Title
DE602005024562T DE602005024562D1 (de) 2004-06-28 2005-06-22 Vorrichtung zur befestigung eines transplantates an einem tunnelierer
EP05762684A EP1773216B1 (fr) 2004-06-28 2005-06-22 Appareil pour fixer un greffon à un dispositif de formation de tunnel
CA002572080A CA2572080A1 (fr) 2004-06-28 2005-06-22 Appareil et procede pour fixer un greffon a un dispositif de formation de tunnel
AT05762684T ATE486530T1 (de) 2004-06-28 2005-06-22 Vorrichtung zur befestigung eines transplantates an einem tunnelierer

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10/878,579 US20050288762A1 (en) 2004-06-28 2004-06-28 Apparatus and method for securing a graft to a tunneler
US10/878,579 2004-06-28

Publications (1)

Publication Number Publication Date
WO2006012193A1 true WO2006012193A1 (fr) 2006-02-02

Family

ID=35094373

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2005/022223 WO2006012193A1 (fr) 2004-06-28 2005-06-22 Appareil et procédé pour fixer un greffon à un dispositif de formation de tunnel

Country Status (6)

Country Link
US (1) US20050288762A1 (fr)
EP (1) EP1773216B1 (fr)
AT (1) ATE486530T1 (fr)
CA (1) CA2572080A1 (fr)
DE (1) DE602005024562D1 (fr)
WO (1) WO2006012193A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009103951A3 (fr) * 2008-02-20 2009-11-26 Central Manchester University Hospitals Nhs Foundation Trust Outil chirurgical et procédé d'utilisation

Families Citing this family (11)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB0810749D0 (en) 2008-06-11 2008-07-16 Angiomed Ag Catherter delivery device
US9750625B2 (en) 2008-06-11 2017-09-05 C.R. Bard, Inc. Catheter delivery device
WO2010123835A1 (fr) * 2009-04-19 2010-10-28 Slobodan Tepic Méthode de fixation de suture et appareil afférent
EP2699179B1 (fr) 2011-04-16 2023-06-07 Kyon AG Système prothétique pour réparation orthopédique
US20140188148A1 (en) 2012-12-27 2014-07-03 Pieter W.C.J. le Blanc Surgical tunneler
US10265096B2 (en) * 2013-03-14 2019-04-23 Medtronic, Inc. Tunneling tool and method for an implantable medical lead extension
EP3060167B1 (fr) 2013-10-25 2022-05-04 Kyon AG Mécanisme de maintien et d'ajustement pour attache chirurgicale
DE102014015316A1 (de) * 2014-10-17 2016-04-21 Cem Cetin Tunnelierer
WO2018075495A1 (fr) * 2016-10-20 2018-04-26 Smith & Nephew, Inc. Dispositifs et procédés de fixation de tissus
US20220409240A1 (en) * 2019-11-18 2022-12-29 Scanlan International, Inc. Tunneler instrument and method for placement of vascular grafts
CN115192861B (zh) * 2022-09-16 2022-12-16 山东百多安医疗器械股份有限公司 一种具有响应性的导管皮下隧道固定装置

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3999551A (en) * 1975-01-07 1976-12-28 Bio-Medical Research, Ltd. Subcutaneous guide assembly
US4545373A (en) * 1983-05-04 1985-10-08 Christoudias George C Silastic tube relay rod
US5665093A (en) 1995-12-11 1997-09-09 Atkins; Joseph R. Surgical implantation method and apparatus
US20030074007A1 (en) 2001-10-12 2003-04-17 Rosengart Todd K. Method and apparatus for performing an anastamosis
US6565594B1 (en) 1997-09-24 2003-05-20 Atrium Medical Corporation Tunneling device

Family Cites Families (21)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US2024982A (en) * 1934-12-19 1935-12-17 Harry C Scott Surgical instrument
US4418693A (en) * 1980-12-10 1983-12-06 Leveen Eric G Vein and tubing passer surgical instrument
US4453928A (en) * 1982-05-10 1984-06-12 The Cleveland Clinic Foundation Catheter tunneling apparatus
US4574806A (en) * 1984-10-01 1986-03-11 Cordis Corporation Tunnelling device for peripheral vascular reconstruction
US4733665C2 (en) * 1985-11-07 2002-01-29 Expandable Grafts Partnership Expandable intraluminal graft and method and apparatus for implanting an expandable intraluminal graft
US4832687A (en) * 1987-12-31 1989-05-23 Smith Iii Ray C Subcutaneous tunneling instrument and method
US5098440A (en) * 1990-08-14 1992-03-24 Cordis Corporation Object retrieval method and apparatus
US5234438A (en) * 1991-04-16 1993-08-10 Neal Semrad Process and device for creating new tunnels in tissue
US5300106A (en) * 1991-06-07 1994-04-05 Cardiac Pacemakers, Inc. Insertion and tunneling tool for a subcutaneous wire patch electrode
US5306240A (en) * 1993-01-21 1994-04-26 Pilling Co. Tunneler and method for implanting subcutaneous vascular access grafts
US5509902A (en) * 1994-07-25 1996-04-23 Raulerson; J. Daniel Subcutaneous catheter stabilizing devices and methods for securing a catheter using the same
US5591226A (en) * 1995-01-23 1997-01-07 Schneider (Usa) Inc. Percutaneous stent-graft and method for delivery thereof
BE1009746A3 (fr) * 1995-11-07 1997-07-01 Dereume Jean Pierre Georges Em Dispositif de capture a introduire dans une cavite d'un corps humain ou animal.
US5849036A (en) * 1996-03-29 1998-12-15 Zarate; Alfredo R. Vascular graft prosthesis
US6355066B1 (en) * 1998-08-19 2002-03-12 Andrew C. Kim Anterior cruciate ligament reconstruction hamstring tendon fixation system
US6251122B1 (en) * 1999-09-02 2001-06-26 Scimed Life Systems, Inc. Intravascular filter retrieval device and method
US6656151B1 (en) * 2000-01-11 2003-12-02 Integrated Vascular Interventional Technologies, L.C. (Ivit, Lc) Vascular access devices and systems
US6712826B2 (en) * 2000-05-17 2004-03-30 Cook Vascular Incorporated Apparatus for removing an elongated structure implanted in biological tissue
US7686807B2 (en) * 2001-03-22 2010-03-30 Interventional Spine, Inc. Tool for bone fixation device
US6752827B2 (en) * 2001-12-04 2004-06-22 Vasca, Inc. Devices, systems, and methods for subcutaneously placing an article
US7128734B1 (en) * 2002-09-20 2006-10-31 Arrow International, Inc. Apparatus and method for reverse tunneling a multi-lumen catheter in a patient

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3999551A (en) * 1975-01-07 1976-12-28 Bio-Medical Research, Ltd. Subcutaneous guide assembly
US4545373A (en) * 1983-05-04 1985-10-08 Christoudias George C Silastic tube relay rod
US5665093A (en) 1995-12-11 1997-09-09 Atkins; Joseph R. Surgical implantation method and apparatus
US6565594B1 (en) 1997-09-24 2003-05-20 Atrium Medical Corporation Tunneling device
US20030074007A1 (en) 2001-10-12 2003-04-17 Rosengart Todd K. Method and apparatus for performing an anastamosis

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009103951A3 (fr) * 2008-02-20 2009-11-26 Central Manchester University Hospitals Nhs Foundation Trust Outil chirurgical et procédé d'utilisation

Also Published As

Publication number Publication date
CA2572080A1 (fr) 2006-02-02
US20050288762A1 (en) 2005-12-29
DE602005024562D1 (de) 2010-12-16
EP1773216B1 (fr) 2010-11-03
EP1773216A1 (fr) 2007-04-18
ATE486530T1 (de) 2010-11-15

Similar Documents

Publication Publication Date Title
US11696751B2 (en) Tissue repair devices
US20240215977A1 (en) Wound closure system
US8758397B2 (en) Vascular closure methods and apparatuses
US11980726B2 (en) Systems and methods for anchoring medical devices
US9398903B2 (en) Knotless locking tissue fastening system and method
CN109310496B (zh) 用于植入心脏瓣膜环的收紧绳
US8920442B2 (en) Vascular opening edge eversion methods and apparatuses
US5354298A (en) Suture anchor installation system
US20030088270A1 (en) Implantable tissue fixation devices and methods of tissue approximation
EP2266469A1 (fr) Appareil pour fixation de tissus mous sur un os
US20080161850A1 (en) Suture anchoring system
TW201225997A (en) Assembly and method for stabilizing a percutaneous cable
US20050288762A1 (en) Apparatus and method for securing a graft to a tunneler
KR20120029376A (ko) 수술 봉합 장치, 그와 함께 이용되는 방법 및 기구
EP2574307B1 (fr) Introducteur de greffon
US9693768B2 (en) Meniscus reattachment device
US20140052177A1 (en) Method and apparatus for attaching soft tissue to bone
WO2015137882A1 (fr) Système pour amélioration cosmétique
US20120053598A1 (en) Helical Fasteners and Methods for Deploying Same
US11547397B2 (en) Devices, systems, and methods for repairing soft tissue and attaching soft tissue to bone
US20090105545A1 (en) Apparatus and method for facilitating the implantation of a medical device
WO2023235278A1 (fr) Œillets ou passants pour tissus mous et dispositifs et méthodes pour leur mise en place
CN119214706A (zh) 一种组织闭合器
CN120693112A (zh) 扩张式外科锚定件

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AE AG AL AM AT AU AZ BA BB BG BR BW BY BZ CA CH CN CO CR CU CZ DE DK DM DZ EC EE EG ES FI GB GD GE GH GM HR HU ID IL IN IS JP KE KG KM KP KR KZ LC LK LR LS LT LU LV MA MD MG MK MN MW MX MZ NA NG NI NO NZ OM PG PH PL PT RO RU SC SD SE SG SK SL SM SY TJ TM TN TR TT TZ UA UG US UZ VC VN YU ZA ZM ZW

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): GM KE LS MW MZ NA SD SL SZ TZ UG ZM ZW AM AZ BY KG KZ MD RU TJ TM AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HU IE IS IT LT LU MC NL PL PT RO SE SI SK TR BF BJ CF CG CI CM GA GN GQ GW ML MR NE SN TD TG

WWE Wipo information: entry into national phase

Ref document number: 2005762684

Country of ref document: EP

WWE Wipo information: entry into national phase

Ref document number: 2572080

Country of ref document: CA

NENP Non-entry into the national phase

Ref country code: DE

WWW Wipo information: withdrawn in national office

Country of ref document: DE

WWP Wipo information: published in national office

Ref document number: 2005762684

Country of ref document: EP